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HomeMy WebLinkAbout0086 MOORING DRIVE - Health �t1t. a:Ey�i'al Ive A= 024 105;.. it f i � J CERTIFIED MAIL ,NE t ' U.S.POSTAGE>>PITNEY BOWES of Qw` Town of Bar `table `' P ° Pi�ic Health) vision * ��I� f (¢. "�►'"wN 9.` g 200 Main A _ ZIP 02601 O 1 10 "rEoiu+° H} nnis,MA , 60I 1 02 1VV 0001383424 APR. 30, 2013. Fn —_ 1 7012 1010 0000 2850 7725 is Suzanne.M.. Cappadona & Kathleen Benson 86 Mooring Dr_ive.- - - - -- ---— - EAV Cotuit MA t�i{ X1. 'yy � cc y 0-(C C 0 9 y � � 3Vt Y l*.�i'`L� l/i,3�. l��i=, ,y- LR�:15: i3'9'���5-J IZ F T Ii,t.Z:i,N TO; S r•'eN D r R WIT OF-A-1VERAR'LF. A" ADDYR�E'15,51VED UNABLE TO FnR,WARD Cs q GC' g 02zs307.t[4G i20�ii ' �g i Z -gE�21�Zs-3gG-4w �f;„ir.,.$...w.i=....�•a�,,.�g•�l�LiLS:P.:l6i.�. 4��i Aellt§3e11i�1��fY li ti!t�9i��1'lll l�f lEllltl Sl'i]9��1A1]..�III•i : ,, SENDER: • SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3:Also complete A. Signature y� j item 4 if Restricted Delivery is desired. ❑Agent I ✓1 i 10 Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes I A. Article Addressed to: _ ��E vcc_e.+�.+e�:,,o..laddress below: ❑No Sumne.M.,Cappadona & Kathleen Benson ?� 86_MVMooring`Drive Cotdit, MA `02635 f J Express Mail i ❑Registered ❑Return Receipt for Merchandise , ❑Insured Mail ❑C.O.D. i 4. Restricted Dellvery?(Extra Fee) ❑Yes I . 2. Article Number (rransfer from service fabeo 7 012 1010 0000 2850 7725 �_, 6 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 Y Town of Barnstable VE F 4 J Department of Regulatory Services Public Health Division Date MASS 200 Main Street,Hyannis MA 02601 a T lfp FAA':� a Date Scheduled / el/&3 Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed BY: Witnessed By: o f > y� • - t LOCAT & GENERAL INFORMATION Location Address 2Y�M0(4Ar-G Cokj Owner's Name —� r�4�, �1 1 Address rA 0 Assessor's Map/Parcel: L� �( '� Engineer's Name NEW CONSTRUCTION REPAIR `V Telephone# ` �; 3 � �ly'I Land Use A C-5 I Slopes 96 y Z' ' ' p ( ) • Surface Stones UU Distances from.: Open Water Body ft Possible Wet Area "' ft Drinking Water Well ft Drainage Way ft Property Line" ZO f ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) LLJCD . . . ° c� LPCQ t` CA 0 Parent material(geologic) Depth to Bedrock Z J Depth to Groundwater. Standing Water in Standing �/ Weeping from Pit Face ry/�► Estimated Seasonal High Groundwater A! a DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: �� �!c� Depth Observed standing in obs.hole: ___ in., Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level a Adj.factor— Adj.Groundwater Level PERCOLATION TEST Date /e TIM L Observation Hole# Time at 4" Depth of Perc r�o Time at 6" r r Start Pre-soak Time @ Q, oG s Time E End Pre-soak ° s Rate Min./Inch z Site Suitability Assessment: Site Passed �� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division " ,, ', Observation Hole Data To Be Completed on Back------------ ***If percolation test is to be conducted within 100' of wetland,you must first notify the. 3 Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC 1 DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. ` onsistency.96 Gravel) DEEP OBSERVATION HOLE LOG . Hole# Z. Depth from Soil Horizon Soil Texture Soil Color ' - Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ZU 2 p S %D Yj C- !o Cy iLi/1—+JE='L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate Man: Above 500 year food boundary No— Yes - Within 500 year boundary No Yes - Within 100 year flood boundary No.:� Yes Depth of Naturallv Occurring Pervious Material Does at least four feet of naturally occurring perv,iu�s material exist in all areas observed throughout the area proposed for the soil absorption system? 6 If not,what is the depth of naturally occurring pervious material? _ Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required train' xpertise and experience described in 310 CMR 15.017. Signature - �--�. Date © 2d 3 Q:\4EPTICkPERCFORM.DOC ------------- =TOWN OF BARNSTABLE LOCATION L � �® �� SEWAGE#_9i 1 .L) 'a,ILLAGE '® ASSESSOR'S MAP&PARCEL ®.3 INSTALLER'S NAME&PHONE+NO. e�� gUy c 5Y ONO SEPTIC TANK CAPACITY � LEACHING FACILITY:(type) \AJQ W%L� ize) �® ` NO.OF BEDROOMS OWNER PERMIT DATE: . I COMPLIANCE DATE: Separation Distance Between the: ^ 1 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site.or'within 200 feet of leaching facility) `" Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY y ' �f J ca 1 �jrr' LJ ' O S W 1Q 11 1i gi i. { No. Po 17 — V ! r Fee r. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippliLation for Dieposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. moo, -\!,� �r, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel s UZ���� �,e 6 0^� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: n Dwelling No.of Bedrooms oC Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ? gpd Design flow provided Z �b gpd Plan Date `S 3 \3 Number of sheets Revision Date Title Size of Septic Tank Myl PyXk S:� Type of S.A.S. e'r.n �.. �'rw�tlr.S l n, Description of Soil k—Cti>\[ �M j r..�NN750a `r+ ICAN Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. �r- Signed Q Date Application Approved by p• Date Application Disapproved by Date for the following reasons Permit No. :?o 13— Date Issued f _ _ G n .T 13 0 M pl Fee No THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes .PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 21pplitation f or'Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair,(/ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Moo( -N n1 �Dr` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel S VZ G`ry\-e,— Cc" e 9�,0 o Installer's Name,Address,and Yef.No. Designer's Name,Address,and Tel.No. s L6� 510 a C► Ob(o� a ��3 Type of Building: nn Dwelling No.of Bedrooms oC Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a gpd Design flow provided gpd Plan Date 13 \ Number of sheets Revision Date Title Size of Septic Tank k 0QU( �e-j,(i Sa Type of S.A.S. \.n Description of Soil �n �`„ f� �3 8�n��e, Sr c Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by � • Date S -.J- Application Disapproved by Date for the following reasons Permit No. �20 13 110 Date Issued �a(4 ---------------------- ------- -- --------- - ------------ - --- ----------- ------------------------------- TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and t e for Disposal System Construction Permit No.a013 � dated s_2 4-13 Installer�`�y(� �('(��L( Designer_� ��, v \ 1 #bedrooms Approved design flow oZ gpd. The issuance of this permit shall not be construed as /guarantee that the system� 4n)dtionl designed.Y / g Date p { Inspector / / d lV -,v ✓I --------------------------�------------------------ --------------------------------------------------------- -------------------------- No. P 01 3 —1 -p1 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at �� M U O C \�� r r_b�j 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit.�!^ Date 6 -" 9 L — 13 Approved by i e Town of Barnstable of RegulaWy<,Services - Thomas F,-Geiler, Director �wsrnBte. . mmS-1639. Public Health Division 10 Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3� 13 Sewage Permit# j�Assessor's MaplParcel 14116 Designer: !�;j�P(-}C-4_2i A- !:�,PC Installer• Address: Z [��4 Address On� was issued a permit to install a (date) (installer) septic system at Y2 r `,`T based-on:a.design drawn by (ad ess) [�PHA A• 14 A,A�, PE dated�S".1 p 3 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed.with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �� JInstallez s Signature) N � (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC.HEALTH'lDI VVISION. CERTIFICATE OF COMPLIANCE -WILL NOT BE ISSUED'UNTIL BOTH=THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Fonn Revised.dc c, - Postal u1 (Domestic • ni pranc�, overage Provided) ri For delivery information visit our website at www.usps.corns Er p U COg Postage $ AN>r//S Certified Fee ,v p yr p Retum.Receipt Fee Postma H p (Endorsement Required) ' ere )V p <p rn Restricted Delivery Fee I� O p (Endorsement Required) p Total Postage&Fees r-� Suzanne M. Cappadona & Kathleen Benson k. 86 Mooring-Drive Cotuit, MA 02635 w t Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your m piece0k.,. s A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 9 . Town of Barnstable Barnstable SST"Lj� . Board r of Health 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-79076304 F7 Paul Canniff, D.M.D. Junichi Sawa ana gi Y 9 � CERTIFIED MAIL #7012 1010 0000 2850 9125' May 16, 2013 Suzanne M.. Cappadona & Kathleen.Benson 86 Mooring Drive Cotuit,.MA 02635.. • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5: The septic system located`86 Mooring Drive,Cotuit,`MA was last inspected on 4/05/2013, by Shawn.M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5,(31.0 CMR 15,00) due to the following. System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action.-,.-:, -PER ORDER OF T E BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the.Board of Health. Q:\SEPTIC\Letters Septic Inspection.Failures or Future Eval\86 Mooring Dr Cotuit Apr 2013.doc Postal CERTIFIED IVIAILWPB�EIPT J3 (Domestic Ln a For delivery I' �• r;�F 0 � � �C, L Ln cc Posteru $ 3Here Certified F 0 O Return Receipt F Cap (Endorsement RequirRestricted Delivery"�(Endorsement RequirEd)Op Total Postage&Fees $ W ( A C Mr. & Mrs. Steven Walske a , % Kurt R Steinkrauss, Trustee Mintz Levin r One Financial Center LBoston MA 02111 Certified Mail Provides: ■ A mailing receipt ` \ ;. s A unique identifier for your mailpiece" ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or,Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signatu Item 4 if Restricted Delivery is desired. X On ❑Agent 0 Print.your name and address on the reverse ❑Addressee so that we can return the card to you. B. Rec 'ved�b (Printe . me) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. -3 -13 D. Is delivery addne.qs different from item 1? ❑Yes A. Article Addressed to: If YES,enter delivery address below: ❑No • I Mrh& Mrs. Steven Walske��'f= <.I % Kurt'R Steinkrauss, Trustee'-': Mintz Levin —1 3. Se ice Type One Financial Center ceWfled Mail Pxpress Mail Boston MA 02111 ❑Registered ffRetum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes JAJ� 2. (uncle Number 7 012 1010 0000 2850 915 6 (Transfer from service label) !I I Pi S Form 381 1,February 2004 Domestic Return Receipt 102595-02-M-1540.I LLI w UNITED STATES PQSTAL.SER ICE First-Class Mail Postage&Fees Paid USPS ' Permit No.G-10 • Gender: (Please print�your name, address, and ZIP+4 in this box • r"A i Town of Barnstable Public Health Division 200 Main Street Hyannis, MA. 02601 9`) J °F r°wy Town of Barnstable Barnstable the Regulatory Services Department e"a j +y, Y Y BA S MASS. 0 Y Public Health Division 9 MA . Apr i639' A 2007 eo"tA` 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 9156 May 30, 2013 Mr. & Mrs. Steven Walske % Kurt R Steinkrauss, Trustee Mintz Levin One Financial Center Boston MA :02111 ATTN: Kurt.Steinkrauss ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 47 Sunset Point, Osterville, MA was last inspected on 4/20/2013 by David Burnie, Sr., a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • The block pit that services the quest house was found to have heavy root infestation;.which has caused blocks to move and be unsafe. It needs to be collapsed and replaced. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. -Failure to repair/replace.the septic system within the deadline period will result in future enforcement action. PER ORDE=RS. RD OF HEALTH ._........ Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\47 Sunset Point Ost May.2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=3399 1 Tt e V i $ d ys Jj1 8 NSTA[ILIc v Logged In As: Parcel Detail Wednesday,May 29 2013 Parcel Lookula Parcel Info Developer Parcel ID 651-615 _ Lot Location j47 SUNSET POINT I Pri Frontage 30 Sec Road Sec Frontage Village JOSTERVILLEm Fire District C-O-MM _ Town sewer exists at this address NO I Road Index F1683 I Asbuilt Septic Scan: InteracMap " 051015_1 Owner Info Owner[WALSKE, STEVEN C&JENNIFER M�_ I �Co-Owner I%STEINKRAUSS, KURT R TR Streetl C/O MINTZ LEVIN I Street2 I ONE FINANCIAL CENTER city BOSTON ( State� Zip[02111 Country F Land Info Acres F747 j Use IMulti Hses MDL-01 I Zoning IRF-1 Nghbd IWF14 Topography Level I Road I Paved I utilities Eublic­Water,Septic Location Waterfront , Construction Info Building 1 of 2 Year 2007 Roof(Gable/Hi ext Wood Shingle Built - --Fi6_6i_­__ _...._I Struct E p I Wall i gI a Living 6045 I Roof Wood Shingle ( AC Central °`- Area Cover Type Style Cape Cod Int Plastered ( Bed 5 Bedrooms �) Wall Rooms 2 Bath Model Residential Fl Int oor Carpet I Rooms i7 Full 2H Grade LUXU Heat Ho Rooms� t Air Total rY Plus Type i 112 � F i Heat Found-. stories 1 3/4 Stories ! Fuel Oil ation iPoured Conc. Gross i 12841 -- Area 1 Building 2 of 2 Bear G946 1 Roof_Gambrel l Ex (Wood Shingle Built! � 1 Struct l Walll http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=3399 5/29/2013 VIoo 5I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w� 47 Sunset Point (guest house) Property Address Jennifer Walske 2.118 Vallejo St San Francisco,CA 94123 Owner Owner's Name information is required for Osterville MA 02655 4/20/13 every page. CitylTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the .p�1 computer,use 1. Inspector: (Q -only the tab key w to move your David Burnie Sr cursor-do not use the return Name of Inspector b key. Neighborhood Waste Water Company Name 350 Main St a =� Company Address „- W.Yarmouth MA 02673 r`a CitylTown State 5 Zip Code 508-775-2820 ' S1386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on Imy training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Sect�w 11 rr 40 of Title 5(310 CMR 15.000).The system: ,\a/�` GF Passes ❑ Conditionally Passes ® =`l� DAV1rJ J. u� ❑ Needs Further Evaluation by the Local Approving Authority = U- #SI385 j'. C, Q•: 4/20113 '42 5 1 N SPE�'� Xspectorsgnatur Date The system inspector shall submit.a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Offici I s on Form.Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Y , wM 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owner's Name information is required for Osterville MA 02655 4120113 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B;C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist..Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ` ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,.will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A Ymetal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y .❑ .N ❑ ND(Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point -(guesthouse) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner owner's Name information is Osterville MA 02655 4/20/13 required for every page. cityrrown State. Zip Code. Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): `C) Further Evaluation is Required by the Board of Health: EI Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1: System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner owner's Name information is required for Osterville MA 02655 4/20/13 every page. CitylTown State Zip Code Date of Inspedion B. Certification (cont.) 2. 7System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system\has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well .. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other'failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Othe The block pit that services the guest house was found to have heavy 7rooltin2festation which h aused blocks to move and be unsafe. It needs to be colla sed andd. i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool E ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow / t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner. Owners Name information is required for Osterville MA 02655 4/20/13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes Na ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone'1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet.of a private water supply well. ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd.i . ® ❑ The system fails:I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 101000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ ' the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 . Commonwealth of Massachusetts G Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owner's Name information is required for Osterville MA 02655 4/20/13 every page. CityrFown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built.plans of the system obtained and examined?(If they were not available note as N/A) E ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 per prior report t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owner's Name information is required for Osterville MA 02655 4/20/13 every page. Cityrrown. State Zip Code Date of Inspection D. System Information Description: This system contains a septic tank and a block pit Number of current residents: 0 Does residence.have a garbage grinder? ❑ Yes ® No " Is laundry on a separate sewage system? (Include laundry'system'inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No 12= 1175gpd Water meter readings, if available(last 2 years usage(gpd))- 11= 1043gpd Detail: Customer has irrigation. Sump pump? ❑ Yes ® No Last date of occupancy: - Seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203)-, Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner - Owner's Name information is required for Osterville MA 02655 4120/13 every page. City/Town state Zip Code Date of Inspection M.System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Neighborhood Waste Water Was system pumped as part of the inspection? ® Yes ❑ No If.yes, volume pumped: 1000 gallons . gallons How was quantity pumped determined? Site glass on truck Reason for pumping: Maintenance Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Night tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owner's Name information is required for Osterville MA 02655 4/20/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Pump chamber was added in 2008 per plan. Septic tank is unkown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2'9„ Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ®other(explain): Cast iron inlet, orangeburg outlet Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Due to pipe being cast iron we recommend it be replace with sch40 PVC. Septic Tank(locate on site plan): Depth below grade: f "for cover and deck Material:of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) *****There is only one cover on the tank, which is an inlet cover. We recommend that the tank be replaced as part of new system installation. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000ga1 Sludge depth: 0 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 : Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM °p 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owner's Name requinformai red don is for Osterville MA 02655 4/20/13 required - every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) t Distance.from top of sludge to bottom of outlet tee or baffle unknown Scum thickness 0 Distance from top of scum to top of outlet tee or baffle unknown Distance from bottom of scum to bottom of outlet tee or baffle unknown How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was pumped as part of, the inspection. However there is only 1 cover that is accessable and that is the inlet cover.'Because of that we couldn't view the outlet end of the tank. Grease.Trap(locate on site.plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑'polyethylene ❑other(explain): f Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 47Sunset Point (guest house) - Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA' 94123 Owner Owner's Name information is required for Osterville MA 02655 4/20/13 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as.related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current,pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 47 Sunset Point (guesthouse) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owners Name information is Osterville MA 02655 4/20/13 required for every page. City/Town state Zip Code Date of Inspection D. System information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): THERE IS NO BOX ON THIS SYSTEM Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS riot located, explain why: The block pit was found and dug up. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guesthouse) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owners Name information is Osterville MA 02655 4/20/13 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: "® leaching pits �. number: 1-6x6 block pit El leaching chambers number: ❑ leaching galleries number: ❑ Teaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of.hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The block pit had roots growing into it. Due to the roots growing into it, the structuraly integrity has been comprimised. It was found dry and it is 2'8"to the cover. t Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owners Name information is Osterville MA` 02655 4/20/13 required for every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) - Privy (locate:on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic.failure, level of ponding, condition of vegetation, etc.): i Y t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owner's Name information is required for Osterville • MA 02655 4/20/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. Check one of the boxes below: ® .hand-sketch rin the area below ❑ 'drawing attached separately, 71A o O C 0 , c 2T7 , 13 _ C ` Zza D Ll 1` 6 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 115 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 47 Sunset Point (guest house) Property Address Jennifer Walske 2118 Vallejo St San Francisco,CA 94123 Owner Owner's Name information is required for Osterville MA 02655 4/20/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) S Site Exam: ® Check Slope - ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 11'+ per plan dated 1982 feet Please indicate all methods used to determine the high,ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1982 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-'explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed_USGS database-explain: MIW-29 Zone A water level 6.9 .8x12= 10"adjustment You must describe how you established the high ground water elevation: Per previous report dated 2004.and available at the Barnstable BOH it shows approximetly 24'to groundwater. From grade to bottom of block pit is 7'6". If you add to that a required seperation of 4' plus the adjustment of 10"you have a total of 12'4". You are out of groundwater by at least 10'. { Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 - Commonwealth of Massachusetts.; Title 5` Official Inspection F®rm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �V Sunset Point (guest house) Property Address Jennifer Walske. 2118 Vallejo St San Francisco,CA 94123 Owner Owners Name . information is required for Osterville MA 02655 4/20/13 every page. _ "City/rown State Zip Code Date of Inspection E. Report Completeness'Checktist -Inspection Summa :A B C D or E checked . Summary: ® Inspection:Summary b(System Failure CriteriaJApplicable to All Systems)completed .'® System-Information—Estimated depth to high groundwater Sketch of Sewage Disposal Systern''either.drawn on page 15 or attached'in separate file t5ins•3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r ..... Town of Barnstable U.S.POSTAGE>>PITNEY E30WES Public Health Division I (/ BARNSfAeL M.- 'p' 200 Main Street 1 o© 0 ZIP FEED MP'�°0 Hyannis,MA 02601 i }^. 02 02601 $ 006.1 10 0001383424 MAY. 16, 201.3. I, 7012 1010 0000 2850 9125 ,5 _ .. _ > ti Suzanne M. Cappadona & Kathleen Benson 86 Mooring Drive Cotuit, MA RETURN TO SEl•,i'DE1t NOT DELIVERABLE AS ADDRESSED j: I- N kiNB1._'E o.0 CR AR0 _ W' � �IiAi7�l�il#f411871141�3e�;.tli-I--f'81114'/31t I114.33A4@�A:399�,4965 jSENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY I A. Signature - ■ Complete items 1,2,and 3.Also complete _--- I item 4 if Restricted Delivery is desired. X ❑Agent, ■ Print your name and address on the reverse ❑Addressee I I so that we can return the card to you. B. Received b Printed Name C. Date of Delivery Y( a --- I ■ Attach.this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes' 1. Article Addressed to: 1_1_If_YFS__enter_deiiverv_address below: ❑No I ' it Suzanne-M. Cappadona & Kathleen Benson W-94" ''bg Drive __,,�Fxpress Mail �❑Registered ❑Return Receipt for Merchandise I t. ❑Insured Mail. ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes \ / I 2. Article Number / I (transfer from service tabei) 7 212 101 iJ 0 0 2 0 2850 912 5 �JI PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 r = tip Town of Barnstable Barn Ml4meftIII City Ba MA Board of Health 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010 0000 2850 9125 May 16, 2013 Suzanne M. Cappadona & Kathleen Benson 86 Mooring Drive Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located 86 Mooring Drive, Cotuit, MA was last inspected on 4/05/2013, by Shawn M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\86 Mooring Dr Cotuit Apr 2013.doc Postal (DomesticCERTIFIED MAIL. RECEIPT For delivery inforMation visit our website at www.usps.corne coPostage $ f !1J Certified Fee 4u r O Postmark C3 Retum.Receipt Fee _. p (Endorsement Required) Herei C3 Restricted Delivery Fee C3 (Enrseme do nt Required) CO Total Postage&Feesrs . ra n]i rq N Suznne M. Cappadona & Kathleen Benson 186 Mooring Drive Cotuit, MA 02635 _ Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece r ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®: • Certified Mail is notavailable for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For, valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. " PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 a IY^ " a t ti Town of Barnstable Barnstable ,,,AM �; Board of Health 1 o;9..,a 200 Main Street, Hyannis-MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010 0000 2850 7725 . April 23, 2013 • Suzanne M. Cappadoha & Kathleen Benson 86 Mooring Drive Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located 86 Mooring Drive, Cotuit, MA was last inspected on 4/05/2013, by Shawn M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\86 Mooring Dr Cotuit Apr 2013.doc Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, � r use only the tab 1. Inspector: (L/� key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones TitleV Septic Inspection r� Company Name 74 Beldan Ln. Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. Tl!& ins ction ,i was performed based on my training and experience in the proper function and..ri �intenanceJof ortrsite sewage disposal systems. I am a DEP approved system inspector pursuantAo Section 15.34e&d `. Title 5(310 CMR 15.000).The system: ° NJ0 ❑ Passes ❑ Conditionally Passes. ® Fairer ❑ Needs Further Evaluation by the Local Approving Authority -ra s rill 4/5/2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. d �I (tiZ e3 t5ins•11/10 Title 5 official In ectl Form:Subsurface Sewage Disposal System•Page 1 of 17 ., Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and'over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20_years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool N ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ M Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either es"or no to each of the following, in addition to the 9 Y Y Y 9 questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? Z ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name' information is required for every Cotuit Ma 02635 4/5/2013 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 � page. Cityrrown State Zip Code Date of Inspection D. System-Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: original system 1980 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line 10+: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: , feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was located but not opened, it is located under deck with access door above inlet Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of'scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. City/Town State .Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was located but not excavated Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and.appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ in system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leach pit was found to be full to the cover resulting in a failing septic inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 86 Mooring Drive Property Address CAPPADONA, SUZANNE M& BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information'(cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Q'Up -o u 0 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts v - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. Citylrown. State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) El Accessed USGS database-explain: You must describe how you established the high ground water elevation: System fails, groundwater elevations were not established Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Property Address CAPPADONA, SUZANNE M & BENSON, KATHLEEN Owner Owner's Name information is required for every Cotuit Ma 02635 4/5/2013 page. CityrFown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ®System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file L t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �IKE Town of Barnstable Barnstable AgAmerlmCft BAMSTAUM • Board of Health, MAC. I Fs639. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010`0000 2850 7725 May 16, 2013 Suzanne M. Cappadona & Kathleen Benson 86 Mooring Drive Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located 86 Mooring Drive, Cotuit, MA was last inspected on 4/05/2013, by Shawn.M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\86 Mooring Dr Cotuit Apr 2013.doc P P 9 P i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 . 3-11-10 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, I ' use only the tab 1. Inspector: key to move your cursor-do not Jason P. Burnie use the return Name of Inspector key. David J Burnie Management Inc ITV Company Name 3 Perry's Way Company Address Harwich MA 02645 City/Town State Zip Code 508-775-3116-----1-866-980-1440 S15011 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes i Q ❑ Conditionally Passes ❑ Fails �-1 ❑ Needs Further Evaluation by the Local Approving Authority 4 Q f 3-12-10 Inspe o Sig Nature Date tV The Sys m inspector shall submit a copy of this inspection report to the Approving Authority(BOard of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage sposal System• e 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Septic tank at normal level, distribution box normal and leaching pit has 6'standing water, leaching pit is an 8' pit. Leaching is estimated to be close to 90%full. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑- broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑. Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 or 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GM , 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply El ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® '❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. Citylrown State Zip Code Date of Inspection D. System Information Description: !000 gallon septic tank, distribution box and 1 leaching pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): yesl Detail: 2009-87.000 gallons=238 gpd...................2008-25.000gallons=69gpd Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. City/Town State Zip Code Date of Inspection D. System Information(cont.) Last date of occupancy/use: Current Date Other(describe below): General Information Pumping Records: Source of information: None per BHD Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Y ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy J ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 . Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Plan dated 7-13-80 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 17" feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town Water 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): None Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain) Unable to open Septic tank, the inlet is under wood deck and the outlet is also under a deck support.Used a sewer camera to view the outlet end of the septic tank from the distribution box. Found the tank at normal level. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 per plan dated 7-13-80 Sludge depth: Unknown t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle unknown Scum thickness unknown Distance from top of scum to top of outlet tee or baffle onknown Distance from bottom of scum to bottom of outlet tee or baffle unknown How were dimensions determined? unknown Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommend that both the inlet and outlet of the septic tank be opened and that the tank be serviced. Grease Trap(locate on site plan): Depth below grade: feet Material of*construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . ,M 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) . Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be opened and serviced. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma: 02760 Owner Owner's Name information is Cotuit MA 02635 3-41-10 required for every page. Citylrown State Zip Code , Date of Inspection D. System Information (cont.)' Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Normal level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of,box, etc.):., Normal level Pump Chamber(locate on site plan): Pumps in working order: . ❑ Yes ❑ No Alarms in working-order, ❑ Yes ❑ No 'Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain'why: Located and viewed with a sewer camera, found 6' standing water in a 8' leaching pit. estimated to be within 15 inches of the inlet pipe or close to 90%full t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 ry R Commomniealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: leaching pits number: 1 6x8 per plan ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches' : number, length: ❑ leaching fields number, dimensions: overflow cesspool; number: ❑, innovative/alternative system Type/name of technology: - Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit is 30 years old and close to 90% full. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert 'Depth of solids layer Depth of scum layer Dimensions.of cesspool Materials of construction Indication of groundwater inflow : ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is Cotuit MA 02635 3-11-10 required for every page. Citylrown State Zip Code Date of Inspection D. System 'Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):, 90%full . Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma.02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. Cityf town State Zip Code Date of.lnspection D. System Information ,(cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately d t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Mooring Drive Cotuit Ma. Property Address Suzanne Cappadona 6 pine cone Ln North Attelboro Ma. 02760 Owner Owner's Name information is required for every Cotuit MA 02635 3-11-10 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 30+/ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7-13-80 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -.explain: plan on file, no water to 12' ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database explain: Town of Barnstable Geographic Information system maps You must describe how you established the high ground water elevation: Town Maps show grade elevation to be Elevation 70 and ground water to be at Elevation 30 seperation is estimated to be 40' IIII Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GM $Vey'�r 86 Mooring DriveCotuitMa. Property Address Suzanne Cappadona&pine cone Ln North Attelboro Ma. 02766, Owner' Owner's Name information is required for every Cotuit MA 02635 3-11-10 . page, City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® -Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria•Applicable to All Systems)completed ® System Information— Estimated depth'to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LOCATION SEWAGE PERMIT NO. F' 6 _ 363 VILLAGE I N S T A L L E 'S� NAME i ADDRESS BUILDER OR OWN Fit DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 s1.,� W� v 0 W � � �. W �/ ,�.�. .� No.......... F• Fss.. ............... W D� THE COMMONWEALTH OF MASSACHUSETTS / BOARD F` HEAL H b ;q Appliratio a for Disposal Works.Tonstrurtion Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System Lam :s , ,19 Locat' n-Addre / y- or Lot No. ......../... . ............ .... .................---� .. ........................ W caner " �a= 42 ......... . ..z ...•.. ..... ...................... ....................•-........................_---•-.- Installer Address U Type of Building Size Lot_c .�.6®a....Sq. feet Dwelling—No. of Bedrooms................•---..--. .-.........Expansionttic j; ) Garbage Grinder ( ) _, _.. No. of persons.................. ....... Showers — Cafeteria Other—Type of Building __�[1F.f�>� ..._. p ( ) ( ) Q' Other fixtures -----------------------------------•-••---•----------------------------- ---------------------......._... .................. .------•------- d W Design Flow............. r.............._....gallons per person pyer day. Total da�l Y��low......w7 Q.._..................._gallons. WSeptic Tank—Liquid ca.pacity.!'M.gallons Length........ Width.&.l�_.___. Diameter................ Depth._.._.._...._... x Disposal Trench—No. .................... Width.................... Total Length...........��.. Total leaching area sq. ft. -__-. Diameter...... ........... Depth below inlet-71...3....... Total leaching area.��._._._s ft. � Seepage Pit No.............� � p g q. Z Other Distribution box Dosing to ( ) aPercolation Test Results Performed by......_L[A�!` � ..�'� -� ?1 L.....--- Date.... 3�® ,.a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to grounS water.... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____ _'. . Description of Soil..... _... --------- - - - . ................ .. .. - - ... 9 - UW -- v -1-tI.-------. ... ----------------------------------................................................................ Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•-----------------------------------------------------------------------•---------•-•........................-------•---•------•-•-----•----------------------•-----•-----•----•------••--............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i I'= 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo of heal Signed . ...... .----- .. Date Application Approved By............... � Ltd$-� --------- ----------------- .--------- -.---7— l -� Date Application Disapproved for the following reasons:.....................:....................................................................................... _ .........................................................................................................................-------------------------------------------------- ............................ Date � Permit No. -- Issued - De------•-•••---------------•--•- z f No..........t3 FimB..... ....._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................JC-...................OF...../.....h/ .'L ` f/7.=l� ........ Appliratilan for Disposal Workii Tonstrnr#iun rantit F Application is,hereby made for a Permit to Construct (>f) or Repair ( ) an Individual Sewage Disposal System at ................. n-Addre or Locatio � Lot No. ----7 f� F ......................F�l ............................... t�l�-s3 /--13.:... ............... .........i-_`............................ZI......................... 6!✓(Address' Installer Address � '�� llll Type of Building Size Lot...:.... ...:..... .....Sq. feet Dwelling—No. of Bedrooms_____________ ___ .............Expansion Attic ( ) Garbage Grinder ( ) p.I Other—Type of Building ._._ No. of persons........._ ...c/... Showers ( ) — Cafeteria ( ) gn fixtures ...................-----=-----------•---_---_ •--•----•----------------•---•-----------•----___•_---------•--------__.....__--------______-•---" W Desi Flow_Other fixgallons per person pe� day. Total daily flow____.p�" �________________________gallons. ..................S` WSeptic Tank—Liquid capacity✓1'(?'.gallons Length.u.__-Z ._ Width................ Diameter..........:..... Depth................ x Disposal Trench—No..................... Width._...._....._...--_ Total Length......__......._. Total leaching area.....................sq. ft. Seepage Pit No...__..._.._1...... Diameter....... Depth below inlet. ._�.___..__ Total leaching area.�C.............sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) Percolation Test Results Performed by........ .............................................' ��0 WDate--��-�---•�---•---•------.. Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to groundwater ._._..._... 44 Test Pit No. 2................minutes per inch Depth of Test.,Pit.................... Depth to ground water........................ W --------...................................................................................................................................................... O Description of Soil..... ------------------------ •---------------------------------------------- •----------------- ------------------------ W /,` - - ... -------------------------•--------------------•.... -----•---------•------------------ W ?(, - ./�J�/ J)/�rl f�L•rf.( •-----------------------------------"--------------............. •-----------•----------------------------------•---------------------"------•------•--•-------_-•.... V Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------•--------------------•------------------------------------•--•--...---•--•---....._..............------------------------------•---------•--•---------•-•---.....................-••_..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been jjissued by the board'of health. / Signed. _ _/�;/-q ae Application Approved By.............. ll .( ,.. .;7 � ... Date Application Disapproved for the following reasons:......................................................................................... ....................... -••-----•-•---"--------------•------.....---------------.._...----------------•-•---•------•-•-------"--•..----------------------------•--------•-----------"---•-------•-------......•----•••------•••- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS f. BOARD OF HEALTH- ......................................... OF.:.... .;.rl 'Jl:.:.y. ............................... C9rd firab.,af T..lampliFanre THIS.r-IS TO CERTIFY, Tha�t+the Individual Sewage .Disposal System constructed V or Repaired ( ) by ...... �.... /[.l.. `f ..................................................................................................... Installer at..............................................................1 a/.............. . -•----- - ............................................................... has been installed in accordance with the provisions of T VAE �5 of The State Sanitary Code as described in the application for Disposal Works Const action Permit N . .,?d o _ ;_3..........__._ dated.... '`'_.f '__ .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................----------------------------- THE COMMONWEALTH OF MASSACHUSETTS ®R)", BOARD >OF HEA/LTjH �i� (.!J/L�...............0 F...:.:.t�I/.,lL S/1 t/ le ..................•---•--..... e No.... 3r:^ r . --••- � FEE.. ..-•---....... c Disposal World .�uns/#rudinn rrntit Permission is hereby granted....----�f. _r ._____... .f_ 1-f.:i-r. ..........n �� i........ ............................................. to Construct (,�) or Repair '(' ) an Individual Sewage Disposal System- —'— Z at No..--•./. J �i.n >✓. . - -�---------••-- ..................... �•-••----------•-•__---•------- -------------------•--•=--r.. .. - -----•--•••••--- Y -Street as shown on the application for Disposal Works Construction Permit No ... _ ___ Dated..... ------------------- �r -------•-•----••-•----- ............................................. and of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS L •. E F.F L. ELEV.= .`". ' FINISH GRADE 6 .7 -''x :l FINISH GRADE FINISH GRADE— TOP OF FOUND, r OVER TANK = yam OVER PIT ELEV. = 4 C.I. 4" V.C. — „ WHERE NEEDED BACKFILL 3'I PEAS TONE DWELLING I Vc1� j I s i s ' O O o O 4 _ b o CELLAR FLOOR /y';, GALLON �• J , v O (� O o ` . a 3/4" TO I-U2 ELEV -- REINFORCED GONC. a .II o O (� O o I �; ° CRUSHED STOVE �f. o io O • o —; —=°; , a — D I T. BOX ?� e I r 0 I t, r (TO BE LEVEL v ,•1 o (� O 0 I: i D �� �` BOTTOM OF PIT SEPTIC TANK o AND STABLE ) ° o O O O o ° Q ELEV. «, SYSTEM PROFILE ! NOT TO SCALE) LEACHING PIT DESIGN CRITERIA q rr � S 7 kUMBER OF SEDROOAS = _------. --- ---_ -__-- --__-- v wx GALLONS PER DAB'" GARBAGE GRINDER TOTAL DAILY FLOW = _ ram R "? LEACHING AREA PROVIDED = Sar zs-o i $� L� -j,•f t Q, X�,a L4 Z) SOILS LOG 'Z1 SA A)b . r. PROPOSED SEWAGE r DISPOSAL SYSTEM } INSPECTED SY-,l J•_ ,t,, PROPOSED DWELLING - ----— DATE �; .- ! 42 MASS. PERCOLATION RATE : r': NKZ INCH SCALE AS NOTED ^DATE A Of ItSRcs'., -- - - - - -- --- �'o 9r GZccv S•G. Fjwray o� idpRN4p,i T4��0 Cpl tsvz_k'x( —,00A ,loTS.S/Gtt,,v aV D4.4/V Tub' &7 SXFt'T 2 -V GROSS iAf� ? C-Nee4G r ;7 I C 2,- i2 {Q • so yA. n fi� rr�►sy iN --- '/�'T• �E'd- 7oxe4 Q� . ° � NORMAN GROSSMAN PE, R L S �Poro, f.LEe� '77,x0 OMaC 226 HOLLY POINT ROAD Ear'/S'�' G'cj•!/�'2au�Lw- "rx., �} CENTERVILLE, MASS . ACCESS COVERS MUST BE WITHIN INSPECTION 9" MIN/MUM. INVERT ELEVATIONS : DESIGN CR I TER I A : GENERAL NO TES : 6` OF FINISH GRADE PORT 3' MAX/MUM COVER FIRST 2" TO INVERT OUT SEPTIC TANK., 100.5 DESIGN FLOW: 2 BEDROOMS, DESIGN FOR FI FI LEVEL INVERT IN DIST, BOX: 100. 12 3 BEDROOMS MINIMUM AT //0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION BE INVERT OUT DI ST. BOX: 99.95 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4. 0/AM PIPE ..INVERT IN LEACH CHAMBER: 99.92 CLEAN SAND BACKFILL NO GARBAGE GRINDER 2. VERTICAL DATUM 1S ASSUMED. FOR BENCH MARKS 100.5 99.95 // - AROUND AND 2' OVER CHAMBERS BOTTOM OF LEACH CHAMBER: 99.0 F71 SET. SEE SITE PLAN. f00. 12 w .'o gg g2 99.0 ADJUSTED GROUND WATER: N/A BAFFLE SEPTIC TANK REQU l RED: 10 HIGH CAPACITY INFILTRATOR OBSERVED GROUND WATER: N/A 3 OUTLET 330 G.P.D. X 200x - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND - EXISTING D-BOX CHAMBERS IN TRENCH FORMATION BOTTOM OF TEST HOLE #l: 92.7 SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DESIGN PERC RATE C 5 MIN/INCH PROFILE : NOT TO SCALE $OIL TEXTURAL CLASS - I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER N EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPO/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. PROVIDED: l0 HIGH CAPACITY INFILTRATOR CHAMBERS. 62.5'x 7.79 SF/FT - 487 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 487 S.F. x 0.74 - 360 GPD APPROVED EQUAL. 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED SOIL TEST PIT DA TA S PRECAST CONCRETE OR APPROVED POLYETHYLENE. INDICATES �_ INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER PERCOLATION OBSERVED TESTED FOR LEVEL WHEN THERE lS MORE THAN ONE TEST GROUNDWATER OUTLET. ti Q TP #l P#/3994 TP #2 7. BEFORE CONSTRUCTION CALL 'D 1 G-SAFE". h2 A g9 L 0 T 6 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. 20. 000-+ U S. F. 0_ HORIZON TEXTURE COLOR 7 103. 0 HORIZON TEXTURE COLOR 103.7 FOR LOCATION OF UNDERGROUND UTILITIES. A LOAMY IOYR A LOAMY IOYR \� SAND 211 SAND 211 � 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE �\ 103.4 6` - - - - - - - - - - - - - - - - - - - - /03.2 6` - - - - - - - - - - - - - - - - - - - - 103.2 LOAMY IOYR LOAMY IOYR DESIGN ENGINEER TWO DAYS PR/OR TO CONSTRUCTION + :. TP+►l B B OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE 103. SAND 516 SAND 516 -'a© - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 101.7 CONSTRUCTION INSPECTIONS. \ / l0 HIGH CAPACITY a 20` - l D2.0 24` INFILTRATOR CHAMBERS oo C/ SILT IOYR C/ SILT IOYR } 103.2 -- c,, LOAM 613 LOAM 6/3 9• EXISTING LEACH PIT TO BE PUMPED DRY AND TPa2 F 40` - - - - - - - - - - - - - - - - - - - - 100.4 40" - - - - - - - - - - - - - - - - - - - - 100.4 BACKFILLED. ' 3,6 AK 0-60x C2 MED/UM IOYR C2 MEO 1 UM IOYR RHOD lE SAND AND 616 SAND AND 616 60` GRAVEL GRAVEL +103.2 -� 103.4 ` NO WATER NO WATER EXISTING �, �. 1)3.3 / !32` 92. 7 120 93.7 2-12"OAKS LEACH PIT � -_ / yo / - / DATE: MAY JO. 20/3 c� TEST BY: STEPHEN HAAS EXISTING\\� SEPTIC TAW ` �oa� // WITNESSED BY: DONNA M10RAND1 ,l 102.& PERC RATE: C 2 MIN/INCH Ile 7 RY n +103.2 ' \QM_CORNER BH 0P \aG y pr xa y . a-103.47 , P u' y u 'z� / UP/� - --_� SEP T l C SYSTEM LEES ! ON 86 MOOR l NO DR l VE . MAP 24 . PARCEL l O5 BARNSTABLE . CCOTU / T ) MA �ww 1 0 1 PREPARED F' OR a$ 0 LEGEND 0 `�j t l Z" 'Q L CUS 0 CB CONCRETE BOUND N N E7 C A P P A D O N A -W WATER LINE SCALE : / 20 MAY 23 20 / 3 O HYDRANT --G GAS LINE t /� /� OHW-- OVER HEAD WIRES S T E R H E N A . H A A S -0 LIGHT POST ENGINEERING , INC C7 --E- UNDERGROUND ELECTRIC LINE 923 R a u t e 6 A -T-- UNDERGROUND TELEPHONE L I NE / \�' Y a r ma u t h p a r t MA . 02675 .�'�` ! 1 -CTV- UNDERGROUND CABLEVISION LINE 1 ������ ( 508 ) 362-8 '1 32 +40.4 SPOT ELEVATION ••40....... EXISTING CONTOUR LOCUS MAP 0 /0 20 40 Pro] PROPOSED CONTOUR JOB NO: l 3-035